Galveston Orientation And Amnesia Test Research Articles

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

Predictors of the duration of post-traumatic amnesia following traumatic brain injury

The duration of post-traumatic amnesia (PTA) helps estimate the level of recovery following traumatic brain injury (TBI). Yet, little information is available about which sociodemographic and clinical variables influence its duration. This study aims to identify them and create a predictive model that makes it possible to estimate the time it takes for a patient to emerge from PTA. The sample consisted of 40 adult patients with PTA admitted to a neurorehabilitation centre. A total of 89.7% had suffered a severe TBI, whereas the remaining 10.3% had had a moderate TBI. Cognitive status was assessed using the Galveston Orientation and Amnesia Test (GOAT) - a scale for determining at what point a patient can be considered to be emerging from PTA. A regression equation was found (F = 8.511; p < 0.001; R2 = 0.415), in which the following variables (ranked in order of importance) explained 41.5% of the variability observed in the duration of PTA: a) GOAT administered on arrival at the neurorehabilitation centre; b) years of formal education of the patient; and c) days with PTA prior to admission to the neurorehabilitation centre. The equation derived was as follows: 104.284 + (-0.708 x GOAT-initial) + (-4.124 x years formal education) + (0.219 x hospital acute-APT). The time it takes for a patient to emerge from PTA is conditioned by the score obtained in the first GOAT administered on admission to the neurorehabilitation centre, their level of education, and the number of days elapsed with PTA between occurrence of the TBI and admission to the neurorehabilitation centre.

The Effect of Foot Reflexology on Amnesia in Patients Undergoing Electroconvulsive Therapy: A Randomized Clinical Trial.

Introduction: Electroconvulsive therapy (ECT) is the oldest procedure among the early biological treatments introduced in psychiatry. However, the most debated and treatment-limiting adverse effect of ECT is amnesia. Therefore, due to the restriction of the use of drugs to manage amnesia in patients undergoing ECT, the present study investigated the effect of reflexology on amnesia.Methods: In this randomized controlled trial, 68 patients who met the inclusion criteria were randomly allocated to intervention and control groups. The intervention group received foot reflexology with olive oil 20 minutes a day for 3 days, while the control group was given a gentle foot rub with olive oil 20 minutes a day for 3 days. The amnesia rate of all patients was measured by the Galveston Orientation and Amnesia Test (GOAT) 30 minutes after the end of ECT. The data were analyzed using SPSS software version 11.5 and t-test, chi-squared test, and repeated measures ANOVA.Results: The results showed that reflexology significantly increased recalling scores in the intervention group compared to the control group. Foot reflexology seems to be effective in managing amnesia in patients after ECT.Conclusion: Foot reflexology, as a relatively simple, inexpensive, and non-invasive technique with few side effects, can be used to manage amnesia in patients after ECT.

Optimizing and simplifying post-traumatic amnesia testing after moderate-severe traumatic brain injury despite common confounders in routine practice

The duration of post-traumatic amnesia (PTA) following traumatic brain injury (TBI) is a key diagnostic and outcome indicator. However, concerningly, different PTA paradigms record different PTA durations: some over-estimate, others under-estimate, PTA. Thus, a compromise is implied. The potential effect of in-hospital confounders including opioids is unknown. Three clinical groups were prospectively recruited. Group-1: in-patients with moderate-severe-TBI (MS-TBI), considered likely ‘in-PTA’. Group-2: patients rehabilitating after recent MS-TBI, considered ‘out-of-PTA’. Group-3: orthopaedic in-patients without TBI undergoing elective surgery. Only Groups 1&3 were taking opioids. All were administered the Westmead Post-traumatic Amnesia Scale (WPTAS) and the Galveston Orientation and Amnesia Test (GOAT). Results were obtained in n = 56 (Group-1:n = 18, Group-2:n = 13 and Group-3:n = 25). On WPTAS, Groups 1&3 scored similarly, but significantly lower than, Group-2 (χ2 = 8.2, P = 0.017). Contrariwise, on GOAT, Group-1 scored significantly lower than Groups 2&3 (χ2 = 23.99, P < 0.001): however, no patient scored GOAT <75. WPTAS showed moderate sensitivity (72%) but poor specificity (40%) in distinguishing Group-1 from Groups 2&3. Contrariwise, GOAT showed 100% specificity but 0% sensitivity. WPTAS ‘day of week’ and ‘pictures’ combined with GOAT ‘transport medium to hospital’, ‘anterograde amnesia’ and ‘retrograde amnesia’ maximized sensitivity (100%), specificity (85–88%), PPV (77–83%) and NPV (100%) in distinguishing Group-1 from Groups 2&3. ConclusionsConfounders including opioids likely affected WPTAS overall, but not GOAT specificity. A merger, whereby WPTAS sensitivity augmented GOAT specificity, was therefore sought. Favourable items from WPTAS (4/12) and GOAT (3/10) together optimized, and yet simplified, PTA testing; despite prevalent clinical confounders. Less, not more, ‘PTA’ items would benefit both patients and staff alike.

Comparing the Westmead Posttraumatic Amnesia Scale, Galveston Orientation and Amnesia Test, and Confusion Assessment Protocol as Measures of Acute Recovery Following Traumatic Brain Injury.

The duration of the acute period of recovery following traumatic brain injury (TBI) remains a widely used criterion for injury severity and clinical management. Consensus regarding its most appropriate definition and assessment method has yet to be established. The present study compared the trajectory of recovery using 3 measures: the Westmead Post-Traumatic Amnesia Scale (WPTAS), the Galveston Orientation and Amnesia Test (GOAT), and the Confusion Assessment Protocol (CAP). Patterns of symptom recovery using the CAP were explored. Eighty-two participants with moderate to severe TBI in posttraumatic amnesia (PTA) on admission to an inpatient rehabilitation hospital. Prospective longitudinal study. Length of PTA (days), agreement between measures (%, κ coefficient), and pattern of symptom recovery. Participants emerged from PTA earliest on the CAP followed the GOAT, and last on the WPTAS. There was good agreement between the CAP and the GOAT as to PTA status, but both tests had poor agreement with the WPTAS. Of patients considered out of PTA on the CAP, the majority exhibited signs of amnesia on the WPTAS and one-third had clinical levels of agitation. The WPTAS identifies a later stage of PTA recovery that requires specialized management due to ongoing amnesia and agitation. The CAP and the GOAT are less sensitive to this extended period of PTA.

Post traumatic amnesia as a predictor for development and recovery of visual field defects following mild traumatic brain injury (mTBI)

Mild traumatic brain injury can trigger long term visual dysfunction in the form of visual field defects which can disrupt the normal lifestyle of any individual and other rehabilitation efforts resulting in social and professional distress. Post traumatic amnesia is one of the predictors of severity in mTBI.The purpose of this study was two fold (i)To find out the association between post traumatic amnesia and visual field defects following mild traumatic brain injury. (ii) The implication of post traumatic amnesia on the development and recovery of visual field defects post mTBI. Hospital based prospective, analytical, observational study. A total of 260 patients with the diagnosis of mTBI were studied. Diagnosis of mTBI was based on the WHO Operational criteria for clinical identification of mTBI.Visual field index (VFI) was taken to estimate the extent of visual field damage because it is a global index which expresses the amount of visual field loss as a percentage relative to the sensitivity of a reference group of healthy observers.The Galveston orientation and amnesia test (GOAT) was applied to assess post traumatic amnesia. The study period was from July 2017 to March 2019. Each patient with mTBI was examined for Visual field defects at 1 month, 6 months and 1 year post injury. The main observation of this study were (i) It is important to look for visual field defects even in mild traumatic brain injury for atleast 6 months post injury because during this period the appearance of visual field defect peaked. (ii) There is a strong possibility of developing visual field defects among the group of patients who presented with the history of post traumatic amnesia following mild traumatic brain injury (P=0.0001) (iii) If a patient with mild traumatic brain injury suffers from visual field defects, possibility of his/her symptoms persisting beyond 12 months increases significantly if there is history of post traumatic amnesia (P=0.0001).Mild traumatic brain injury can trigger long term visual dysfunction in the form of Visual field defects. Our results will help in providing information regarding development, progress and outcome of visual field defects following mild traumatic brain injury.

The association between post traumatic amnesia and visual photosensitivity in mild traumatic brain injury

Background: Visual symptoms are a common occurrence following mTBI. Among visual symptoms, Visual photosensitivity is a frequent manifestation post mTBI, which can disrupt the normal lifestyle of any individual resulting in social and professional distress. Post traumatic amnesia is one of the markers of severity in mTBI. Authors have studied the association between visual photosensitivity and post traumatic amnesia following mTBI. The aim of this study is to find out the association between Visual Photosensitivity and post traumatic amnesia in patients with mild traumatic brain injury.Methods: Hospital based prospective, analytical, observational study. A total of 300 patients with the diagnosis of mTBI were studied. Diagnosis of mTBI was based on the WHO Operational criteria for clinical identification of mTBI.VLSQ-8 Questionnaire was used in this study to diagnose and monitor the progress of visual photosensitivity in patients with mTBI. The Galveston Orientation and Amnesia Test (GOAT) was applied to assess post traumatic amnesia. The study period was from July 2017 to March 2019. Each patient with mTBI who developed visual photosensitivity was followed up for 1 year after the appearance of their symptoms.Results: Thus the main observations of this study were (i) There is a strong possibility of developing visual photosensitivity among the group of patients who presented with the history of post traumatic amnesia following mild traumatic brain injury (p=0.0008)(ii) if a patient with mild traumatic brain injury suffers from visual photosensitivity, possibility of his/her symptoms persisting beyond 6 months increases significantly if there is history of post traumatic amnesia (p=0.0001).Conclusions: This result will help in providing information regarding prognosis of visual photosensitivity following mild traumatic brain injury.

Prevalence of Post Traumatic Amnesia after Mild Closed Traumatic Brain Injury by Galveston Orientation and Amnesia Test

Objective: We evaluated the frequency of post traumatic amnesia (PTA) in close mild traumatic brain injury (TBI) via. Galveston Orientation and Amnesia Test (GOAT).Materials &amp; Methods: A total of 115 patients with mild TBI, both male and female, aged between 14 to 60 years and presenting within the first 6 hours were included. Assessment with the GOAT was performed within 6 hours of admission. Post traumatic amnesia was recorded.Results: Patients’ mean age was 39.21 years. Majority of the patients (64.34%) were between 36- 60 years of age. Prevalence of post traumatic amnesia (PTA) in closed mild TBI was found in 27.83% patients, whereas, there was no post traumatic amnesia in 72.17% patients. Mean admission GCS was 14.54 and the mean GOAT score was 83.89 in all patients GCS 14/15. There was more prevalence of PTA in age 36-60 years, in male patients and “time since injury” in &gt;3 hours. Mean GOAT was 68.3 in patients (30.19%) with PTA with GCS 14, whereas, mean GOAT was 74.8 in patients (25.80%) with PTA with GCS 15.Conclusion: 30.19% patients with GCS 14, were positive for PTA (GOAT: 68.3). Overall, 28% patients were positive for PTA. This study concluded that prevalence of post traumatic amnesia in mild TBI is relatively high in our study as compared to other recent reports.Abbreviations: TBI: Traumatic Brain Injury. PTA: Post Traumatic Amnesia. GOAT: Galveston Orientation and Amnesia Test. GCS: Glaucoma Outcome Scale. LOC: Loss of Consciousness. CT: Computed Tomography.

Evaluation of Functionality After Head Injury in Adolescents

The Occupational Therapy Head Injury Mini Screen (OT HIMS) is a screening tool for patients admitted with traumatic brain injury (TBI) in the acute care setting. It is a combination of the Galveston Orientation and Amnesia Test (GOAT) and the Cognistat (formally the Neurobehavioral Cognitive Status Examination). Its purpose is to identify cognitive deficits in patients and to provide education for patients on the impact of these deficits on daily living. Our hypothesis for this study was that cognitive functionality outcome varies with severity of head injury (manifested by Glasgow Coma Scale [GCS]) at admission and tests that identify cognitive deficits can be reserved for patients admitted with severe head injury. Data were prospectively collected for all patients with TBI (DRG International Classification of Diseases-9th Rev.-Clinical Modification codes 800.0-801.99 + 850-859.9), aged 13-21 years, over 10 years. The inclusion criteria are patients had to be awake and have adequate physical function to complete the test. Patients with cognitive deficits were identified using GOAT and Cognistat. Preexistent deficits were also identified. Scores on OT HIMS were compared with GCS at admission. Outcomes also included discharge to home or rehabilitation centers. Hospital deaths were not included in the study. Six hundred nine patients were reviewed, and 248 were administered the OT HIMS. Eighty-three suffered some impairment. The mean GCS for the 248 patients was 13.96 (+/-2.16). A coefficient of correlation between GCS and GOAT score of only 0.224 and an R2 value of 0.050 indicated no correlation between these results. Comparing GCS and the presence of impairment identified by Cognistat yielded an R2 value of 0.093, indicating no correlation between these parameters. Among the patients whose results showed cognitive deficits on OT HIMS, 38% had impairments before injury. Interestingly, only 58% of patients with deficits before injury also demonstrated impairments on OT HIMS. Of the 248 patients, 12 went to rehabilitation centers and this was not correlated with GCS. In this study, admission GCS did not predict performance on the OT HIMS after injury in this cohort of patients with adequate recovery to take the examination. Cognitive functionality can be impaired after TBI of even minimal degree. All patients admitted for TBI should be screened for cognitive deficits before discharge. Long-term follow-up for this group must be performed for maximal therapy and optimal outcomes.

Intoxication au monoxyde de carbone et amnésie antérograde

Carbon monoxide (CO) intoxication is still one of the most frequent conditions causing brain damage as a result of hypoxia in Morocco, and the main area of brain damage is the hippocampus. The role of the hippocampus in the memory process has been known for long and we usually associate hippocampus damage with anterograde amnesia. Nevertheless, the pure amnesic syndrome is retrieved in the isolated damage of the hippocampus as is seen in the anoxia caused by CO intoxication. The outcome of the patterns depends on the extent of brain damage, the age of onset and the early diagnosis. This study presents the case of a young female patient who presented with anterograde amnesia after massive and prolonged accidental exposition to CO that presented disproportional radiological and clinical outcome. Primary care was in the intensive care unit during 24 hours and based on oxygen therapy and diuretics. The psychiatric examination found an acute stress disorder and symptoms of delirium in the form of reduced awareness and memory deficit. The amnesia was anterograde and the patient exhibited diminished ability to remember time, space and persons. The Galveston orientation and amnesia test (GOAT) score on awakening in the intensive care unit was 46. The laboratory findings did not provide direct physiological disturbances. The brain computed tomography (CT) scan revealed bilateral hippocampus low-density in the cerebral white and grey matter. The clinical and the radiological outcome of this pattern were not correlated. The GOAT scores were 46 on the 10th day and 50 when the patient was discharged three weeks later, although the brain CT scan showed a decrease of the low-density in the hippocampus. Forty-five days later, the GOAT score was still 49 and the brain CT scan did not show any low-density lesion. Clinical symptoms of a major depressive episode were installed. These results are correlated to the findings of several series in which the CT scans in CO intoxication show common characteristic features that are symmetrical low-density lesions in the cerebral white matter in some specific brain structures such as the globus pallidus and the hippocampus. The early diagnosis is usually difficult because the brain CT scan findings do not always provide morphological changes and fail approximately one half of the time to detect low-density in the white matter of the hippocampus, and the use of MRI is not as easy as the CT scan. The long period of unconsciousness, the white matter damage and the late diagnosis result in complications in the outcome.

Étalonnage de la version française du Children’s Orientation and Amnesia Test (COAT-VF), questionnaire d’évaluation de l’amnésie post-traumatique chez l’enfant

Introduction The duration of post-traumatic amnesia (PTA), the period of altered memory that often follows traumatic brain injury (TBI), is a useful index of severity of TBI and a predictor of outcome after TBI. Yet, evaluating PTA in French-speaking brain-injured children is not standardized. Objective We aimed to translate into the French language and standardize the Children’s Orientation and Amnesia Test (COAT), inspired by the Galveston Orientation and Amnesia Test (GOAT), which estimates PTA duration in adults. Method Development of a French version of the COAT (COAT-VF) with 16 items: 7 of general orientation, 5 temporal orientation and 4 memory. Normative data were collected for 137 children aged 4, 6, 8 and 10 years who were attending school. Results Performance on the COAT-VF was influenced by age and sociocultural factors but not sex. Conclusion The COAT-VF, short and simple to administer, allows for an accurate evaluation of PTA duration in French children.

Comparison of the O-Log and GOAT as measures of posttraumatic amnesia

Primary objective: To compare PTA severity and duration assessments made by Orientation Log (O-Log) and the Galveston Orientation and Amnesia Test (GOAT) and the relationship of data yielded by these assessments to rehabilitation outcomes.Research design: Retrospective study.Methods and procedures: O-Log, GOAT, demographic, length of stay, and Functional Independence Measure (FIM) data among 83 inpatient subjects with recent TBI requiring inpatient care were reviewed.Main outcomes and results: PTA severity and duration as assessed by the O-Log and the GOAT are statistically similar and correlate similarly with rehabilitation LOS and discharge total FIM score. Simple linear regression models suggest that O-Log scores better predict rehabilitation outcomes than GOAT scores.Conclusions: Although the O-Log and GOAT perform similarly as measures of PTA severity and duration, PTA assessments using the O-Log offers better prediction of rehabilitation outcomes. Further study of the O-Log as an alternate assessment of PTA is warranted.

A multicentre, randomised trial examining the effect of test procedures measuring emergence from post-traumatic amnesia

Background: Post-traumatic amnesia (PTA) tests that record different PTA durations in the same patient, thereby raising measurement accuracy issues, have been reported previously. A major problem lies in determining the...

Multidimensional Assessment of Acute Confusion After Traumatic Brain Injury

Sherer M, Nakase-Thompson R, Yablon SA, Gontkovsky ST. Multidimensional assessment of acute confusion after traumatic brain injury. Objectives To describe the phenomenology of posttraumatic confusional state (PTCS) and to provide preliminary validation of a new procedure, the Confusion Assessment Protocol (CAP), for assessing PTCS. Design Criterion standard investigation. Setting Inpatient traumatic brain injury (TBI) rehabilitation program. Participants Two consecutive series of patients (n=62, n=93) with TBI admitted for inpatient rehabilitation. Interventions Not applicable. Main outcome measures Clinical diagnosis of delirium based on Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria, classification of posttraumatic amnesia (PTA) based on the Galveston Orientation and Amnesia Test (GOAT), and Disability Rating Scale score at time of rehabilitation hospital discharge. Results Agreement between the diagnosis of PTCS with the CAP and DSM-IV classification of delirium was 87%, and agreement between PTCS and PTA using GOAT criteria was 90%. Patients classified as in PTCS sustained more severe injuries and required longer rehabilitation stays. Confusion status was associated with poorer functional status at rehabilitation discharge. Conclusions The CAP is a brief, structured, repeatable measure of multiple neurobehavioral aspects of PTCS. Confusion status as determined by CAP assessment contributed to prediction of outcome at rehabilitation discharge after adjustment for other potential predictors.

Acute predictors of real-world outcomes following traumatic brain injury: a prospective study

Primary objective: To determine whether the recovery of acute attention and memory improves the prediction of real-world outcomes over that provided by standard demographic and injury-severity measures.Research design: Participants were recruited consecutively at the time of injury and followed prospectively at 1 (time 1, or T1) and 4 years (time 2, or T2).Methods and procedures: Measures of attention and memory and the Galveston Orientation and Amnesia Test (GOAT) were administered to 94 participants daily from the time of injury until the criterion was met. Sixty-three per cent returned at T1 and 53% returned at T2. Outcomes were psychosocial distress, return to work and/or school, and quality of life.Main outcomes and results: Recovery of attention, memory and orientation did not significantly improve prediction of outcomes at T1, but did so at T2. At T2, recovery of free recall of three words over 24 h was a more sensitive predictor of psychosocial distress and return to productivity than the GOAT.Conclusions: Free recall of three words may be a useful acute clinical test to enhance prediction of long-term outcomes.

Acute confusion following traumatic brain injury

Primary objective: To determine the incidence, duration and symptoms associated with acute confusion/delirium among traumatic brain injury (TBI) neuro-rehabilitation admissions.Research design: Prospective evaluation of neurobehavioural impairments following TBI among inpatient neurorehabilitation admissions.Methods and procedures: Eighty-five consecutive TBI model system patients were evaluated using measures of orientation, cognition, motor restlessness and delirium.Main outcomes and results: Fifty-nine individuals met Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition Delirium Diagnostic Criteria (DDC) on initial evaluation and 42 of these resolved delirium during inpatient rehabilitation. Multivariable logistic regression analyses revealed significant unique associations of the Galveston Orientation and Amnesia Test (GOAT), Delirium Rating Scale, Cognitive Test for Delirium and time elapsed since injury with DDC status.Conclusions: Findings indicate that delirium is common among neuro-rehabilitation admissions with TBI. Use of a single measure (e.g. GOAT) will result in poor characterization of the multi-faceted symptom complex shown by patients with post-traumatic confusion.

Validity of the Orientation Log, relative to the Galveston Orientation and Amnesia Test.

To establish the validity of the Orientation Log (O-Log) by comparison with the Galveston Orientation and Amnesia Test (GOAT). Correlation of daily measures of orientation. Acute rehabilitation hospital. Sixty-eight inpatients receiving rehabilitation following traumatic brain injury (TBI). The O-Log and GOAT. There was a significant correlation between the GOAT and O-Log (r = .901, P<.001). A cutoff of 25 on the O-Log was found to be comparable with the 75 cutoff on the GOAT. The scales were equivalent in measuring duration of posttraumatic amnesia. The O-Log is a valid measure of orientation for people with TBI and offers some advantages in administration over the GOAT.

Are Aphasic Patients Who Fail the GOAT in PTA? A Modified Galveston Orientation and Amnesia Test for Persons with Aphasia

Because the Galveston Orientation and Amnesia Test (GOAT) requires oral or written response, it risks misclassifying as amnestic aphasic patients who are not, in fact, amnestic. To correct for possible classification errors due to anomia, a modified multiple-choice format of the GOAT (AGOAT) was developed. The average GOAT score of 10 control nonaphasic head-injured patients suggested that an AGOAT score of 90 corresponds to the standard GOAT cutoff of 75 for resolution of posttraumatic amnesia (PTA). Using this criterion, 8 of 15 aphasic head-injured patients who technically were classified as amnestic on the GOAT were classified as nonamnestic on the AGOAT.

Does loss of consciousness predict neuropsychological decrements after concussion?

To investigate the importance of loss of consciousness (LOC) in predicting neuropsychological test performance in a large sample of patients with head injury. Retrospective comparison of neuropsychological test results for patients who suffered traumatic LOC, no LOC, or uncertain LOC. Allegheny General Hospital, Pittsburgh, Pennsylvania. The total number of patients included in this study was 383. Neuropsychological test measures, including the visual reproduction, digit span, and logical memory subtests of the Wechsler memory scale (revised), the Trail Making test, Wisconsin Card Sorting test, Hopkins Verbal Learning test, Controlled Oral Word Association, and the Galveston Orientation and Amnesia test (GOAT). No significant differences were found between the LOC, no LOC, or uncertain LOC groups for any of the neuropsychological measures used. Patients who had experienced traumatic LOC did not perform more poorly on neuropsychological testing than those with no LOC or uncertain LOC. All three groups demonstrated mildly decreased performance on formal tests of speed of information processing, attentional process, and memory. The results of this study cast doubt on the importance of LOC as a predictor of neuropsychological test performance during the acute phase of recovery from mild traumatic brain injury. Neuropsychological testing procedures have been shown to be sensitive in measuring cognitive sequelae of mild traumatic brain injury (concussion) in athletes. The failure of this study to find any relationship between LOC and neuropsychological functioning in a large sample of patients with mild head trauma calls into question the assignment of primary importance to LOC in grading severity of concussion. This study also does not provide support for the use of guidelines that rely heavily on LOC in making return-to-play decisions. Continued research is necessary to determine the relative importance of markers of concussion in athletes.

A validity study of the WAIT in closed head injury

This investigation is a validity study on an instrument designed to assess the cognitive status of CHI patients in the acute phase. The Wolinsky Amnesia Information Test (WAIT) is a questionnaire, orally administered and then scored in a standardized format. Interrater reliability has been previously demonstrated. In this study, the WAIT was compared to the Galveston Orientation and Amnesia Test (GOAT), CT scans, and the Glasgow Coma Scale (GCS). Seventy-five subjects participated in the study, all hospital trauma patients at an urban regional trauma centre, who had been referred to the neuropsychology consult service for cognitive testing. Patients were screened to rule out preexisting developmental, drug, alcohol, or documented prior LOC history. Patients' ages ranged from 18-59, with a mean of 33.45 years. A large majority of the patients (81.3%) were diagnosed with a mild level of CHI. Concurrent, discriminative, and construct validity of the WAIT were investigated, and found satisfactory. The data were submitted to factor analysis in order to uncover underlying constructs. In addition to the 'orientation' and 'amnesia' factors identified through factor analysis, a third factor was found and labelled: 'personal temporal/continuum memory'. Limitations of the study and possible directions for future research are discussed.